20 Hz Transcranial Alternating Current Stimulation Inhibits Observation-Execution-Related Motor Cortex Excitability

Determining the corticospinal, intracortical and motor function responses to transcranial alternating current stimulation of the motor cortex in healthy adults: A systematic review and meta-analysis

BACKGROUND

Transcranial Alternating Current Stimulation (tACS) employs low-intensity sinusoidal currents to influence cortical plasticity and motor function. Despite extensive research, inconsistent results require a comprehensive review of tACS efficacy.

OBJECTIVE

This study systematically assesses tACS effects on corticospinal and intracortical excitability, and motor function over the motor cortex (M1), focusing on alpha, beta, and gamma frequencies.

METHODS

Relevant studies were identified through database searches and citations were tracked until July 10, 2023. The methodological quality of the included studies (29) was evaluated by Downs and Black. Data synthesis involved meta-analysis (n = 25) and best evidence synthesis (n = 5).

RESULTS

Meta-analysis revealed that alpha and beta tACS with intensities > 1 mA and tACS with individualized alpha frequency (IAF) increased corticospinal excitability (CSE). tACS over M1 improved motor function, irrespective of stimulation frequency and intensity. Sub-analysis showed that alpha and beta tACS with an intensity ≤ 1 mA led to improved motor function, while gamma tACS at 2 mA enhanced motor function. Additionally, beta tACS at a fixed frequency of 20 Hz, as well as both low gamma (30-55) and high gamma (55-80) tACS, resulted in improved motor function. A stimulation duration of 20 min led to improvements in both CSE and motor function, and tACS with electrode sizes smaller than 35 cm2 and an electrode montage over M1-supraorbital region (SOR) were found to enhance motor function. Notably, both online and offline tACS improved motor function, regardless of stimulation factors.

CONCLUSION

tACS modulates CSE and improves motor function, with outcomes dependent on stimulation parameters and timing.

Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective

Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be taken as accessorial physical therapy methods on symptom reduction of stroke patients. We suggest that top-down and bottom-up stimulation techniques combined with action observation treatment synergistically might develop into valuable physical therapy strategies in neurorehabilitation after stroke. We explored how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. The proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.